Sealing clip, delivery systems, and methods

ABSTRACT

A sealing clip for sealing or holding punctures or openings in tissue closed is applied from the inner surface of the tissue. In one embodiment, the clip has piercing members for penetrating the tissue from an inner surface thereof adjacent the opening. A delivery apparatus is used to releasably hold the clip in one configuration for introduction of the clip through the puncture or opening and expand the clip to a more open configuration for pulling the clip through the tissue as the delivery apparatus is retracted. Further retraction of the delivery apparatus causes the edges of the tissue surrounding the opening to move along the clip and come together after which the clip is released and closed to hold the tissue edges of the opening together. In the case where the clip has a memory set closed shape, the clip returns toward that shape after being released to hold the tissue edges of the opening together, thereby holding the opening closed.

FIELD OF THE INVENTION

The present invention relates generally to the field of surgical devicesand more particularly to surgical devices and methods for sealingperforations in body organs or vessels.

BACKGROUND OF THE INVENTION

An ever increasing number of diagnostic and interventional surgicalprocedures are performed using catheters introduced into the body at oneor a few entry sites. By limiting the number and size of incisions,patients are able to recover more quickly and with less discomfort. Withthe wide range of catheters at their disposal, surgeons can operate orperform diagnostics on a great number of bodily systems, including butnot limited to the vascular, nervous, and reproductive systems.Following these procedures the catheters and various accessories areremoved, leaving one or more puncture sites which must be closed. Thesesites are often difficult to suture because they are on internal tissuesor organs, are located on arterial walls below the skin, or are onlyaccessible by a catheter. The present invention relates to procedures inwhich physicians do not have direct access to the tissue surrounding anopening in arterial walls or other biological tissue walls using suture.

As an example of the type of puncture closing that is problematic,consider interluminal procedures performed on the vascular system, suchas an angiogram or angioplasty. The skin is punctured through to thefemoral artery, and an introducer sheath is placed in the puncture. Forinterluminal vascular procedures, the introducer sheath is a tube havinga lumen and an outer diameter in the range of 2 mm (6 F on the frenchcatheter scale) to 15 mm (45 F) or more. Catheters are inserted throughthe introducer sheath and threaded towards the heart or other vascularsite of interest. At the conclusion of the procedure, the catheter isremoved, followed by the removal of the introducer sheath. Bleeding atthe puncture site has conventionally been controlled by the use ofmanual compress upstream from the puncture site. Achieving homeostasiswith manual compression, however, is time consuming and can result incomplications. Generally, compression must be applied for one-half houror more to achieve hemostasis. If anticoagulants are used, it may takean additional 2 to 4 hours for the effects of the anticoagulants to wearoff and for compression to be effective. Direct complications frommanual compression include occlusion of underlying blood vessels, whichcan lead to ischemia and/or thrombosis. In general, the problems andpatient discomfort increase with introducer sheath size and the use ofanticoagulants.

Various attempts to achieve hemostasis without the problems associatedwith manual compression have been made. Many of the attempts involvedfacilitating vessel closure using tools compatible with ancillarydevices used with catheter procedures. Complicated remote controlledmechanisms for suturing are inserted through the introducer sheathfollowing catheter removal, for example. These attempts have includedthe use of collagen plugs to seal the puncture, the use of complicated,remote controlled mechanisms for suturing, the application of fastenerssuch as hooks, clips, or staples applied from the exterior of an artery.While each of these devices can be used for closing a puncture morerapidly than manual compression, other problems can result from theiruse. For example, suturing devices may require many cooperating movingparts to pass the suture from one side of the artery to the other, aswell as knot pushers for pushing knotted sutures or mechanisms for knottying. Collagen plugs do not avoid all blood loss, and may increase therisk of thrombosis formation and the development of an inflammatoryautoimmune reaction. Closing punctures using fasteners often involvesthe use of excessive force in the area surrounding their application,which can cut off or greatly reduce blood flow to the adjacent areas.This can cause ischemia and impair the healing process.

In addition many locations where closing is required are not easilyvisible, resulting in difficulty in placing the fastener, collagen plug,or any of the other devices described above.

Minimally invasive surgery, especially minimally invasive surgery usingrobotic techniques, presents further problems for known fasteningtechniques. In minimally invasive surgery, the surgeon has access to thebody through small openings and often must work in restricted spaces orcavities. However, many known techniques are not compatible withminimally invasive techniques.

For procedures where incisions or punctures are internal to the body orpercutaneous, the conventional hemostasis methods of choice are suturesand fasteners, which are usually staples. It is important that thepuncture closing device work rapidly and accurately, and that it doesnot subject the vessels (e.g., arteries) to any undue force. The use ofany of the available devices or methods can result in problems and leadto complications with the surgical procedure, which can delay patientrecovery or jeopardize the patient's health. Therefore, there is a needfor improved devices and methods for closing punctures or other openingsin bodily tissue or organs following surgery.

SUMMARY OF THE INVENTION

The present invention involves methods and apparatus for closing and/orsealing tissue openings that overcome disadvantages of the prior art.The invention is particularly useful for closing and/or sealing tissueopenings in situations where access to the opening is limited, such asin minimally invasive surgery.

According to one embodiment of the invention, a surgical clip isprovided comprising an elongated member and a pair of biasing mechanismscoupled to the member, the elongated member comprising shape memorymaterial and having a memory set closed configuration from which it ismoveable to a plurality of open configurations, the biasing mechanismsbeing selectively adjustable to bias the clip toward any of theplurality of open configurations. With this construction, the clip canbe introduced through an opening in tissue and expanded so that its endsare directed toward the inner surface of the tissue adjacent the openingand pulled therethrough. After the clip is pulled through the tissuesurrounding the opening so that the clip bridges the opening, the tissueand/or clip can be manipulated so that the tissue slides along the clipto the central region of the clip, thereby approximating the tissueedges surrounding the opening. The ability to apply the fastener fromthe interior area of the tissue to the exterior area of the tissuewithout sutures and accompanying knot tying steps is advantageous. Theclip can then be allowed to return toward its memory set configurationwhere it can hold the tissue edges together and seal the opening.Further, the biasing mechanisms can be symmetrically arranged about theelongated member. This can enhance the ability to accurately positionthe clip ends beneath the tissue adjacent the opening.

According to another embodiment of the invention, a surgical clip isprovided comprising an elongated member and a pair of biasing mechanismscoupled to the member, the elongated member comprising shape memorymaterial and having a memory set closed configuration from which it ismoveable to a plurality of open configurations, the biasing mechanismsbeing selectively adjustable to bias the clip toward any of theplurality of open configurations, each biasing mechanism comprising abiasing member and an actuator, each biasing member adapted to apply abiasing force to the elongated member to urge the elongated member awayfrom the closed configuration, and each actuator being coupled to one ofthe biasing members and adapted to activate the biasing member to applythe biasing force to the elongated member.

According to another embodiment of the invention, a surgical clip isprovided comprising an elongated member and a pair of biasing mechanismscoupled to the member, the elongated member comprising shape memorymaterial and having a memory set closed configuration from which it ismoveable to a plurality of open configurations, the biasing mechanismsbeing selectively adjustable to bias the clip toward any of theplurality of open configurations, the elongated member further havingtwo tissue piercing members secured to and engaging said elongatedmember and extending therefrom.

According to another embodiment of the invention, a surgical clip isprovided comprising an elongated member and a pair of biasing mechanismscoupled to the member, the elongated member comprising shape memorymaterial and having a memory set closed configuration from which it ismoveable to a plurality of open configurations, the biasing mechanismsbeing selectively adjustable to bias the clip toward any of theplurality of open configurations, the elongated member further havingtwo tissue piercing members integrally formed therewith.

According to another embodiment of the invention, a delivery mechanismis provided to deliver the clip through a tissue opening, open the clip,move the clip through tissue adjacent the opening so that the clipbridges the opening and the tissue edges surrounding the opening can beapproximated, and release the clip. In addition, the delivery apparatusmay optionally remove piercing members at the clip ends. In onevariation, a surgical clip delivery apparatus is provided for deliveringa surgical clip comprising an elongated member and a pair of biasingmechanisms coupled to the member, the elongated member comprising shapememory material and having a memory set closed configuration from whichit is moveable to a plurality of open configurations, the biasingmechanisms being selectively adjustable to bias the clip toward any ofthe plurality of open configurations, each biasing mechanism comprisinga biasing member and an actuator, each biasing member adapted to apply abiasing force to the elongated member to urge the elongated member awayfrom the closed configuration, and each actuator being coupled to one ofthe biasing members and adapted to activate the biasing member to applythe biasing force to the elongated member, the apparatus comprising abody member having an opening adapted to allow the surgical clip to passtherethrough for release thereof; a clip holder disposed in the bodymember and adapted to releasably hold the surgical clip; and acontroller having multiple actuator engaging surfaces disposed in thebody member, the multiple surfaces configured to engage the clipactuators to adjust the force that the biasing member applies to theclip.

According to another embodiment of the invention, a surgical system isprovided for closing an opening in tissue, the system comprising aself-closing clip, a body member, a clip holder, and a controller; theself-closing clip comprising an elongated member and a pair of biasingmechanisms coupled to the member, the elongated member comprising shapememory material and having a memory set closed configuration from whichit is moveable to a plurality of open configurations, the biasingmechanisms being selectively adjustable to bias the clip toward any ofthe plurality of open configurations, each biasing mechanism comprisinga biasing member and an actuator, each biasing member adapted to apply abiasing force to the elongated member to urge the elongated member awayfrom the closed configuration, and each actuator being coupled to one ofthe biasing members and adapted to activate the biasing member to applythe biasing force to the elongated member; the body member having anopening adapted to allow said surgical clip to pass therethrough forrelease thereof; the clip holder disposed in said body member andadapted to releasably hold said surgical clip; and the controller havingmultiple actuator engaging surfaces disposed in said body member, saidmultiple surfaces configured to engage said clip actuators to adjust theforce that the biasing member applies to said clip.

According to another embodiment of the invention, a surgical system isprovided for closing an opening in tissue comprising and elongated bodymember and a surgical clip; the elongated body member having a proximalend and a distal end adapted for introduction into a tissue opening, theelongated body member further having an opening therein; and thesurgical clip having ends, an open configuration and a closedconfiguration, the surgical clip being releasably coupled to theelongated body member and arranged so that when in said openconfiguration the clip ends extend from the body member opening atdiametrically opposed portions of the body member and generally pointtoward the proximal end of the body member so that when the body memberis introduced into the tissue opening and the surgical clip moved to theopen configuration, the ends of the surgical clip can penetrate thetissue adjacent the opening therein when the body member is retracted.

According to another embodiment of the invention, a method is providedfor closing an opening in tissue having an outer surface and an innersurface comprising introducing a self-closing clip, which has ends, anopen configuration and a memory set closed configuration, through theopening; positioning the self-closing clip in an open configuration withthe ends directed toward the inner surface of the tissue; passing theends through the tissue adjacent to the opening; closing the opening;and allowing the self-closing clip to return toward its closedconfiguration.

The above is a brief description of some deficiencies in the prior artand advantages of the present invention. Other features, advantages, andembodiments of the invention will be apparent to those skilled in theart from the following description and accompanying drawings, wherein,for purposes of illustration only, specific forms of the invention areset forth in detail.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1A to 1E diagrammatically illustrate a clip sealing a vesselopening according to the present invention, where FIG. 1A shows thevessel opening, FIG. 1B shows a clip placed within the vessel, inaccordance with the present invention, prior to insertion through thevessel wall, FIG. 1C shows the clip in an open position placed about thevessel opening, FIG. 1D shows an optional step of removing piercingmembers at the ends of the clip prior to closing the clip, and FIG. 1Eshows the clip in a closed configuration holding the vessel openingclosed and sealing the vessel;

FIGS. 2A, 2B, 2C, 2D, and 2E present several cross-sectional viewsthrough the vessel corresponding to those indicated in FIG. 1A to 1E;

FIG. 3 illustrates a perspective view, including cut-away sections, ofone embodiment of a clip delivery apparatus of the present invention;

FIGS. 4A to 4E illustrate one embodiment of a clip of the presentinvention, where FIG. 4A shows a top plan view of the clip in an openconfiguration, FIG. 4B shows the clip of FIG. 4A in an intermediateconfiguration, and FIG. 4C shows the clip of FIG. 4B in a closedconfiguration, and where FIGS. 4D and FIG. 4E are partialcross-sectional views of the clip;

FIGS. 5A to 5C illustrate further clip embodiments having piercingmembers at the clip ends for insertion into tissue, where FIG. 5A is atop plan view of the clip in an open configuration, FIG. 5B is across-sectional view of removable piercing member, and FIG. 5C is across-sectional view of a piercing member configuration where thepiercing member is fixedly secured to a portion of the clip;

FIG. 6 is an exploded perspective view of a clip release mechanism ofthe present invention usable with the clip delivery apparatus of FIG.3A;

FIG. 7 is an assembled perspective view of the clip release mechanism ofFIG. 6 with the clip of FIG. 6 releasably coupled thereto;

FIGS. 7A and 7B are further views of the clip release mechanism of FIG.7, where FIG. 7A illustrates the release mechanism lockingly engaging orholding the clip and FIG. 7B illustrates the release mechanism releasingthe clip;

FIGS. 8A to 8E are sequential diagrammatic views of the clip deliveryapparatus and clip release mechanism of FIGS. 3, 6 and 7 being used toseal a wound, where FIG. 8A shows the clip in a partially openconfiguration within the delivery apparatus for introduction into avessel opening, FIG. 8B shows the clip being retracted in the deliveryapparatus into a more open configuration, FIG. 8C shows the clip fullyopened and partially extending from the delivery apparatus, FIG. 8Dshows the fully opened clip seated in the tissue, and FIG. 8E shows theclip released from the delivery apparatus, fully deployed and in aclosed configuration;

FIG. 9 is a perspective view of another embodiment of a clip deliveryapparatus of the present invention, including a piercing member removalmechanism;

FIGS. 10A and 10B are retracted and extended views, respectively, of thedistal end of the apparatus of FIG. 9, showing a clip removal mechanismin a retracted and deployed position;

FIG. 10C is a front view of the apparatus of FIG. 10B;

FIGS. 11A to 11E diagrammatically illustrate the clip delivery apparatusof FIG. 9 sealing a tissue opening with a clip having removable piercingmembers, where FIG. 11A shows the clip coupled to the clip deliveryapparatus and placed through a vessel opening and within the vesselprior to piercing the vessel wall, FIG. 11B shows the deployed piercingmember removal mechanism, FIG. 11C shows the clip after it has piercedthe tissue and with the piercing members inserted into the deployedpiercing member removal mechanism, FIG. 11D shows the clip with thepiercing members removed, and FIG. 11E shows the clip detached from theclip delivery apparatus and in a closed configuration in the vesseltissue;

FIGS. 12A to 12C show a mesh embodiment of the piercing member removalmechanism intercepting portion in use, where FIG. 12A shows the clipwith piercing member approaching the mesh, FIG. 12B shows the piercingmember being forced through the mesh, and FIG. 12C shows the piercingmember passed through the mesh and removed from the clip; and

FIGS. 13A to 13C show another embodiment of the piercing member removalmechanism intercepting portion in use, where FIG. 13A shows the clipwith the piercing member approaching the intercepting portion, FIG. 13Bshows the piercing member being forced through the intercepting portion,and FIG. 13C shows the piercing member retained by the interceptingportion, which impedes or precludes withdrawal of the piercing member.

DETAILED DESCRIPTION OF THE INVENTION

Before the present invention is described, it is to be understood thatthis invention is not limited to the particular embodiments or examplesdescribed, as such may, of course, vary. Further, when referring to thedrawings, like numerals indicate like elements.

The present invention provides an apparatus and method for sealingpunctures or other openings in bodily tissues and is both effective andcompatible with many of the tools and techniques employed in minimallyinvasive surgery.

Although the invention will be described in connection with sealingpercutaneous punctures to the femoral artery or to the aorta followingbypass surgery as an aid in achieving hemostasis, it should beunderstood that it has other applications. It may be used or adapted tobe used on other bodily tissues or organs to facilitate hemostasis ofother types of wounds, openings or punctures as would be apparent tothose skilled in the art.

According to one aspect of the invention, a surgical fastener or clip,such as a self-closing clip, is introduced through a tissue opening,which can be made percutaneaously or by other known means such asminimally invasive means, positioned below the opening, and manipulatedto pass through the tissue edges surrounding the opening where thetissue edges are then brought together along the clip. The clip is thenclosed to hold the tissue edges of the opening together.

Referring to FIGS. 1A-E and 2A-E, an exemplary diagrammatic illustrationof one embodiment of the invention is shown. FIGS. 1A-E show perspectiveviews and FIGS. 2A-E show corresponding cross-sectional views of avessel opening closure method using a fastener or clip generallydesignated with reference numeral 10. As shown, clip 10 is used tofacilitate closing the opening by piercing the vessel wall from theinside of the vessel as will be described in more detail below.

The illustrative diagrammatic example shows artery A having an arteriallumen or interior I and an arterial wall W with a perforation or openingO to be closed. The opening O may be a percutaneous opening formed in anartery A, where the opening has been made through the skin and tissue(not shown) surrounding the artery. Alternatively, the surgeon canincise the artery to form the opening as part of a minimally invasivesurgical procedure or other procedure where access to the opening islimited. Returning to the figures, Clip 10 is shown with two ends andpiercing members 12 removably attached thereto. Further, clip 10 can bearranged in at least two configurations: an open configuration 20 (FIGS.2B-D) and a closed configuration 30 (FIG. 2E). Open configuration 20 isused to allow piercing members 12 to pierce wall W as shown in FIGS.1B-C and 2B-C. After the tissue is moved along the clip to close theopening as shown in FIGS. 1E and 2E, the clip is allowed to return toits closed configuration 30, where it holds the tissue edges together.Clip 10 is delivered to the interior of artery A and then placed in openconfiguration 20 with piercing members 12 pointed toward wall W. Clip 10can be held or restrained in open configuration 20, by componentsintegral to or removable from the clip and/or components coupled to theclip as will be discussed in more detail below. With clip 10 in openconfiguration 20, piercing members 12 are pushed through wall W onopposite sides of opening O, as shown in FIGS. 1C and 2C. Afterinsertion through wall W, piercing members 12 can be removed from clip10 if desired, as shown in FIGS. 1D and 2D. Under some conditions theremoval of piercing members 12 is not required or possible, and they maybe left attached to clip 10. The surgeon brings the tissue edgestogether along the clip with the surgeon's fingers or an instrument suchas a clip delivery apparatus described below. Clip 10 is then closed orallowed to self-close, when a self-closing clip is used, and return toor assume closed configuration 30, which can be a loop configuration,thereby securing or holding together the opposing sides or tissue edgesof opening O.

According to another aspect of the invention, clip delivery apparatuscan be provided to facilitate the placement and/or closure of the clip.For example, such a delivery apparatus can be provided to hold clip 10to introduce it to the site of opening O either through the interior Ialong artery A, or through the opening O. The delivery apparatus can,for example, deliver the clip through the opening when closing apuncture following minimally invasive procedures. In such a procedure,access to the body interior is achieved by maintaining a tissue openingthrough the placement of a cannula or sheath through a tissue puncture.During the procedure, various catheters and other instruments are placedthrough the cannula or sheath. At the conclusion of the procedure, theinstruments and cannula or sheath are withdrawn, and the puncture isthen closed. In many instances, the puncture is percutaneous or hasotherwise restricted access. Thus, use of a clip delivery apparatus thatcan be inserted into the puncture prior to cannula removal and that canseal the opening after cannula removal is compatible with minimallyinvasive procedures.

Referring to FIG. 3, one embodiment of a clip delivery apparatus isshown in accordance with the invention. As noted above, the apparatuscan be delivered through a cannula in a minimally invasive procedure.FIG. 3 is a perspective view of clip delivery apparatus 300 fordelivering a clip to a desired site. Delivery apparatus 300 extends froma proximal end 309 to a distal end 305, and includes a sheath or tubularouter body member 301 having an outer knob 304 near the proximal end,and an inner member 303 (which can be a solid or tubular rod) extendingsubstantially along the length of the delivery apparatus and having aninner knob 306 secured thereto or formed therewith at the proximal endof the apparatus.

A slot 307 bisects a distal portion of sheath 301 in a longitudinaldirection and extends along diametrically opposed portions or sides ofthe distal end portion of the sheath. Delivery apparatus 300 providesfor the delivery of a clip through slot 307 through actuation of innerknob 306 and/or outer knob 304. Outer knob 304 is connected to sheath301 near proximal end 309 by, for example, welding or gluing, or it isformed therewith so that outer knob 304 can be used to axially translateor rotate sheath 301 along or about inner member 303. Inner knob 306 isconnected to inner member 303 such as by welding or gluing, or it can beformed therewith. In turn, the distal end of inner member 303 is coupledto a clip holding and release mechanism or it can form part of such amechanism. The clip holding and release mechanism facilitates deliveringa clip to a target site and deploying it. One clip holding and releasemechanism is shown in FIGS. 6-8 in accordance with one aspect of theinvention. With knob 306 secured to inner member 303, knob 306 can beused by an operator or surgeon to axially translate or rotate innermember 303 relative to sheath 301 to actuate the clip holding andrelease mechanism and load a clip in or deploy a clip from apparatus300.

Delivery apparatus 300 has a generally cylindrical shape that terminatesin a curved or blunt distal end portion. This shape facilitates the useof the device to remotely place clips through surgical openings in abody and release the clips from distal end 305. Although slot 307 isshown bisecting sheath 301, other configuration that allow the clip topass therethrough with the open ends of the clip sufficiently spaced tobridge the opening can be used.

One embodiment of a clip constructed in accordance with the presentinvention and suitable for use with clip delivery apparatus 300 (or clipdelivery apparatus 900 described below) is illustrated in FIGS. 4A-4Fand designated with reference numeral 410. Clip 410 includes anelongated member 401, having an outer surface 423, and multiple biasingmechanisms 405, which include coils or biasing members 407 and rings ordisks 409. Disks 409 also may be referred to as actuators as theyactivate biasing members or coils 407 when forced thereagainst. Clip 410is symmetric in that clip member 401, clip ends or restraint members 403and biasing mechanisms 405 are symmetrically positioned about axis A,which bisects the U-shaped clip as shown, for example, in FIG. 4A. Thesymmetric aspect enhances one's ability to symmetrically open the clipand/or accurately position the clip ends through the desired portions ofthe target tissue so that the clip bridges the opening. For example, theclip can be positioned to bridge diametrically opposed portions of theopening.

In general, clip 410 comprises a shape memory member 401, which can havea closed memory set configuration as shown for example in FIG. 4F, andcoils or biasing members 407 positioned therearound to urge or bias theclip member toward an open configuration when the coils are compressed.Clips comprising shape memory members surrounded by coils that movetoward an open configuration when the coils are compressed are describedin the following U.S. Patent, Patent Applications, and PatentPublications all of which are incorporated herein in their entirety:U.S. Pat. No. 6,514,265, application Ser. Nos. 09/090,305 and09/089,884, both entitled Tissue Connector Apparatus and Methods andfiled Jun. 3, 1998, and Ser. No. 09/260,623, entitled Tissue ConnectorApparatus and Methods, and Ser. No. 09/259,705, entitled TissueConnector Apparatus With Cable Release, both filed Mar. 1, 1999, andU.S. Patent Application Publication Nos. 2002-0010490, entitled TissueConnector Apparatus and Methods, and 2001-0018592, entitled Bridge ClipTissue Connector Apparatus and Methods. Also incorporated herein are PCTpublications WO 99/62409, which and corresponds to InternationalApplication No. PCT/US99/12563, which claims priority to the abovementioned Ser. No. 09/090,305 and 09/259,705, and WO 99/62406, whichcorresponds to International Application No. PCT/US99/12566, whichclaims priority to above mentioned Ser. No. 09/089,884 and 09/260,623.Both WO 99/62409 and WO 99/62406 published on Dec. 9, 1999.

According to one embodiment, clip member 401 comprises a deformable wire401 made of shape memory alloy or superelastic material. A nickeltitanium (nitinol) based alloy may be used, for example. The nitinol mayinclude additional elements which affect the yield strength of thematerial or the temperature at which particular pseudoelastic or shapetransformation characteristics occur. The transformation temperature maybe defined as the temperature at which a shape memory alloy finishestransforming from martensite to austenite upon heating (i.e., A_(f)temperature). The shape memory alloy preferably exhibits pseudoelastic(superelastic) behavior when deformed at a temperature slightly aboveits transformation temperature. At least a portion of the shape memoryalloy is converted from its austenitic phase to its martensitic phasewhen the wire is in its deformed configuration. As the stress isremoved, the material undergoes a martensitic to austenitic conversionand springs back to its original undeformed configuration.

When clip 410 is positioned in tissue and allowed to return toward itsclosed state, a residual stress is present in member 401 to maintain thetissue tightly together. In order for the pseudoelastic member or wire401 to retain sufficient compression force in this configuration, itshould not be stressed past its yield point in its deformed delivery oropen configuration to allow full tendency toward its undeformedconfiguration. The shape memory alloy can be selected so as to besuitable with the application. For example, it can be selected with atransformation temperature suitable for use with a stopped heartcondition where cold cardioplegia has been injected for temporaryparalysis of the heart tissue (e.g., temperatures as low as 8-10 degreesCelsius).

It is to be understood that the shape memory alloy may also be heatactivated, or a combination of heat activation and pseudoelasticproperties may be used, as is well known by those skilled in the art.

The cross-sectional diameter of the member or wire 401 and the length ofmember 401 will vary depending on the specific application. The diameterof member or wire 401 may be, for example, between about 0.001 and 0.015inch. For percutaneous vascular applications, the diameter is preferablybetween about 0.001 and 0.008 inch with a diameter “D” of the loop ofmember 401 with coils 407 thereon is between about 0.0125 and 0.0875inch (FIG. 4C). The diameter “D” of the loop formed by member 401 in itsclosed position is preferably sized to prevent movement between adjacenttissues. Although member 401 is shown with a circular cross-sectionalshape (see e.g., FIG. 4E), it is to be understood that member 401 mayhave other cross-sectional shapes such as rectangular or elliptical, orit may be formed from multiple strands.

The wire (e.g., wire 401) may be formed in the shape illustrated in FIG.4F by first wrapping the wire onto a mandrel and heat treating the wireat approximately 400-500 degrees Celsius for approximately 5 to 30minutes. The wire is then air quenched at room temperature. The coil canbe formed from any suitable material such as platinum alloy, nitinol, orstainless steel wire with a diameter of about 0.0005-0.005 inch.

Returning to FIG. 4A, each biasing mechanism 405 includes a helicalcompression spring or coil 407, having an inner surface 419 and an outersurface 417, and a ring or disk 409. Each compression spring extendsfrom one of a respective restraint 403 to one of the pair of rings ordisks 409. Each restraint 403 can form an end of member 401. Further,the materials for rings or disks 409 and clip member ends 403 are chosenprimarily to be biocompatible and rigid. Suitable materials includeplatinum alloy, nitinol, or stainless steel. The restraints can beintegrally formed with clip member 401 or formed from clip member 401by, for example, physically working the ends of member 401 to form anenlarged portion or thermally or chemically treating the ends of clipmember 401 to form an enlarged portion. Alternatively, the restraintscan be separately formed and secured to an end of member 401 such as bywelding, gluing or swaging. Each restraint is configured to prevent arespective spring 407 from sliding thereover and off member 401. In theillustrative embodiment, each end or restraint member 403 is in the formof a spherical ball that is sized with a diameter greater than that ofthe respective end portions of spring or coil 407 adjacent thereto. Itshould be understood that restraints 403 can have other shapes thatpresent a restraining face to the ends of springs 407 as well,including, but not limited to cylindrical shapes having a diametergreater than that of the ends of springs 407, elliptical or conicalshapes having such a diameter, button shapes and T shapes.

Referring to FIGS. 4A & B, the length of the visible portion of member401 is designated with reference character S₁. This visible portion islocated between the pair of rings 409, while the balance of the lengthof member 401 is obscured by either springs 407 or rings 409, and ishidden from view.

Coils 407 and rings or disks 409 are adapted and/or arranged to slidealong clip member 401 while transmitting a biasing force to clip memberends 403. This can be seen in the cross-sectional details shown in FIG.4D & E. Each spring 407 has a first end 411 that seats against one ofthe clip member ends 403 and a second end 413 that seats against one ofrings 409, specifically against a spring seating surface 415. The innerdiameter of each spring is greater than the outer diameter of clipmember 401 so that the spring can slide along member 401. Similarly eachof rings 409 has a hole 425 with a diameter larger than the diameter ofclip member 401 so that the rings can slide along member 401. FIG. 4Cshows each spring 407 in contact with a corresponding one of restraints403 and a corresponding one of rings 409. The inner surface of thesprings or rings may touch various portions of clip member 401 dependingon the size of member 401, coils 407 and rings 409 and the configurationof the clip. Although clip 410 has been shown and described as beingsymmetrical, it need not necessarily be symmetrical. Examples ofvariations that can be used include providing a clip member that is notsymmetrical between clip ends 403, providing clip ends 403 that differfrom each other in size and/or shape, and providing biasing members 405that include springs 407 of differing size and/or length. Still othervariations include providing clip ends or restraints that differ incomposition or method of attachment and/or springs 407 having differentspring constants or any combination of the variations described above.It also should be understood that these variations are provided forpurposes of example and that other variations also can be made withoutdeparting from the scope of the invention.

Returning to FIGS. 4A and 4B, biasing members 405 individually impartforces on clip member 401 to open clip member 401. As more force isapplied to clip 401, it tends to move toward a more open configuration.In the illustrative embodiment, rings or disks 409 are slidably mountedover clip member 401 and present inner and outer surfaces 415, 417 fortransferring forces to their respective springs 407. As one appliesforce to outer surfaces 417 of rings 409, the inner surfaces 415 ofrings 409, which are in contact with the spring, move spring ends 413toward clip ends or restraints 403, which interface with spring ends411. As rings 409 move toward clip ends or restraints 403, coils orsprings 407 are compressed between rings 409 and restraints 403. Thus,for example, one can increase the bias force F to increase the cliplength between rings 409 and increase spring compression. Alternatively,a forcing mechanism, such as the apparatus shown in FIG. 7, can be usedto move rings 409 away from one another to compress springs 407 and openclip 410.

Three clip configurations and a schematic representation of the biasforces are shown in FIGS. 4A-4C for decreasing amounts of bias force.The most open configuration 410A (FIG. 4A) has a bias force F equal toF₁, creating a visible clip length S between rings 409 equal to S₁ andcausing clip ends 403 to have a spacing X therebetween equal to X₁. Anintermediate configuration 410B (FIG. 4B) has a smaller bias force Fequal to F₂ (where F₂<F₁), a visible clip length S equal to S₂ (whereS₂<S₁), and clip member ends 403 with a spacing therebetween X equal X₂(where X₂<X₁). A closed configuration 410C (FIG. 4C) has an even smallerbias force F equal to F₃ (where F₃<F₂) and the visible clip length Sequal to S₃ (where S₃<S₂). In closed configuration 410C (FIG. 4C) ends403 cross, forming a loop 427 in the central portion of clip 410. Inthis configuration, S₃ is zero and the spring force (F₃) is greater orequal to zero. FIG. 4F illustrates clip member 401 in its memory shapeand without biasing members 405. Although particular visible lengths Sof clip member 401 or spacings between rings 409, clip member endspacings X, and biasing forces F, as well as various clip configurationsare shown, it should be understood that variations may be had withoutdeparting from the scope of the invention.

Referring to FIGS. 5A-5C, another clip embodiment is shown and generallyindicated with reference numeral 510. Clip 510 has an open configuration410A, intermediate configuration 410B and closed configuration 410C, andis the same as clip 410 with the exception that clip 510 furtherincludes a pair of piercing members 501, which as illustrated can beconical. Further clip 510 may or may not include enlarged ends 403. Eachpiercing member 501 includes a tip 503 constructed for piercing tissueand can be formed from, fixedly secured to, or releasably coupled toclip member 401. FIGS. 5B and 5C show two different versions of clip 510where FIG. 5B illustrates a piercing member that is releasably coupledto clip member 401 and FIG. 5C illustrates a piercing member that isfixedly attached to clip member 401.

Referring to FIG. 5B, a clip 510′ is shown according to one embodimentof the invention with a removable piercing member 501′ that isreleasably coupled to clip end or restraint 403. Piercing member 501′,which can be conical, has a flexible receiving end 505 for receiving anend 403 of member 401. Receiving end 505 has a chamber or cavity formedtherein for receiving a respective clip end 403. The diameter of thechamber opening in the receiving end 505 of each piercing member 501′ issmaller than a diameter of the enlarged clip end such that the clip endmay be readily snapped into and out of the piercing member. Eachremovable piercing member also can have a thinned cross-section adjacentto the opening formed therein to enhance the ability to releasably snapthe clip end into and out of the tissue piercing member. When the clipend is spherical, the opening in receiving end 505 can be circular witha diameter that is slightly smaller than the diameter of the sphericalclip end. When other clip end shapes are used, the opening is suitablyconfigured to mate therewith and facilitate a similar snap fit so thatthe clip end can be releasably locked in the tissue piercing member.

Referring to FIG. 5C, a clip 510″ is shown according to anotherembodiment of the invention with a piercing member 501″ fixedly attachedto the end of clip member 401. When a clip member having a circularcross-section is used, the end of clip member 401 can terminate or bepositioned in a cylindrical hole or bore 506 formed in piercing member501″. Piercing member 501″ can be press fit, soldered, glued orotherwise attached to clip member 401. Further, piercing members 501′and 501″ can form the clip end or spring restraint member to so thateach spring is compressed between a respective piercing member and disk409. It also should be understood that piercing members 501″ can beintegrally formed with clip member 401 as described above.

According to another aspect of the invention, a clip holding and releasemechanism is provided. The holding and release mechanism enables one tohold the clip and introduce the clip through a tissue opening, pass theclip through tissue adjacent the opening from the inner surface thetissue to the outer surface of the tissue, and to release the clip so asto allow the clip to return toward its closed configuration. The holdingand release mechanism can be constructed to provide an infinite numberof clip positions between the aforementioned open and closedconfigurations.

Referring to FIGS. 6, 7, 7A and 7B, one embodiment of a clip holding andrelease mechanism for use with clip delivery apparatus 300 is shown andgenerally designated with reference numeral 600. Clip release mechanism600 is shown in an exploded view in FIG. 6, an assembled perspectiveview of in FIG. 7, and in diagrammatic sectional views in FIGS. 7A andB.

Referring to FIGS. 6 and 7, clip holding and release mechanism 600 isplaced in sheath 301 of clip delivery apparatus 300 (FIG. 3) and can beused in conjunction with clip 410, 510, 510′, or 510″. Clip releasemechanism 600 generally comprises a body member or clip actuatorcontroller 620, having a hole or bore 621 formed therein, and a clipholder 611 slidably mounted in bore 621. A distal end of inner member303 of clip delivery apparatus 300 is secured to the proximal end ofclip holder 611, such as by welding or gluing, for proximally ordistally translating the clip holder in bore 621. The distal end portionof body member 620 has a longitudinal slot 623 formed therein, which isaligned with slot 307 in sheath 301 before body 620 is secured in sheath301. Slots 307 and 623 are sized to allow the clip to pass therethrough.With the slots aligned, body member 620 is secured in position in sheath301. Body 620 can be constructed to form a friction fit with sheath 301or it can be attached to the sheath through other known means such asgluing, soldering or welding.

Body member or controller 620 also has distally arranged or locatedsloped surfaces 625, which generally form a tapered section in thedistal direction and through which slot 623 extends, and proximallyarranged or located parallel surfaces 627 into which slot 623 alsoextends. Surfaces 625 and 627 provide a mechanism to apply force againstthe biasing mechanisms of the clip or control the movement of biasingmember actuators 409 and move the clip toward an open or closedconfiguration as will be described in more detail below with referenceto FIGS. 8A-E. Although slot 623 is shown as bisecting surfaces 625 and627 to provide an indication of the clip location and facilitateaccurate placement or centering of the clips beneath a tissue opening,it should be understood that the slots need not necessarily be solocated and can be otherwise arranged to facilitate bridging the openingwith the clip.

Clip holder 611 comprises a spring clamp having arms which curve towardone another at the clip holder distal end 602. When the clip holderdistal end is closed, it holds the clip as shown in FIG. 7A and when itis open, it releases the clip as shown in FIG. 7B. More specifically, asclip holder 611 is moved distally in bore 621, the inner wall surfaces650 of body member 620 bias the clamp to a closed or near closedposition where there is no gap or an insufficient gap between the clamparms at distal end 602 to allow the clip (e.g., clip 510) to passtherethrough (FIG. 7A). As clip holder 611 is retracted or movedproximally within bore 623 the inwardly curved portions of the clamparms move outwardly toward their relaxed state to engage opposed walls650, which are spaced from one another by a fixed distance generallyindicated with reference numeral 652 (FIG. 7B). This allows the gapbetween the arms at the distal end 602 of holder 611 to increase and theclip to pass therethrough. Although a fixed or constant distance betweenthe working walls 650 is shown and described, other configurations canbe used. For example, walls 650 can be stepped at their proximal end soas to increase distance 652 in one step and allow the clamp arms toexpand or walls 650 can be sloped outwardly in a distal direction. Ineither of these examples, the clip holder arm configuration can remainas shown or other configurations can be used such as one with a 90°angle formed near the distal ends of the arms. Other variations also canbe made without departing from the scope of the invention.

When loading clip delivery apparatus 300 with a clip, clip holder 611 ismoved proximally until the clamp arms of clip holder 611 aresufficiently spaced to allow a clip, such as clip 510, to passtherethrough (see e.g., FIG. 7). The clip is then introduced throughslots 307 and 623 with rings or disks 409 positioned outside sloped ortapered surfaces 625 (FIG. 7) and then moved proximally through theopening between the clamp arms ends of clip holder 611 (FIG. 7B). Clipholder 611 is then moved distally to the distal end portion of body 620where the clip assumes an intermediate configuration. In thisconfiguration, the clip delivery apparatus is ready for use. As will bedescribed in more detail below, the sloped surfaces of body member 620progressively increase or decrease the space between rings 409 and theparallel surfaces maintain a constant space between rings 409.Specifically, the portion of clip member 401 located between rings 409passes through slot 623 and rings 409 seat on opposite surfaces 625. Bytranslating the clip, such as clip 510, proximally along sloped surface625 towards parallel surfaces 627, the separation between rings 409increases, causing the clip to open further as shown in the progressionfrom FIGS. 8A to 8C.

An exemplary description of the operation of apparatus 300 will be madewith reference to FIGS. 8A-8E, clip 510 and clip release mechanism 600in connection with closing an opening in a femoral artery. It should beunderstood, however, that this example is provided for purposes ofexample and is not intended to limit the scope of the invention. Forexample, the apparatus can be used to close openings other than those ina femoral artery as set forth above.

Referring to FIG. 8A, clip delivery apparatus 300, having clip 510loaded therein and biased away from a closed configuration, isintroduced through an opening in tissue T and through opening O in wallW of femoral artery A. Opening O may or may not have a cannula or sheath(not shown) placed therethrough for maintaining the opening.Specifically, the clip delivery apparatus may be placed through a tissueopening to the site of opening O, or may be placed through a cannula orsheath. It is usually the case in surgical procedures, and in particularin minimally invasive procedures that the opening O is a percutaneousopening having a trocar through which various surgical devices areprovided access to artery A. In the example of FIG. 8A, the clipdelivery apparatus 300 has been inserted into the trocar (not shown),which is removed prior to sealing opening O and more specifically beforethe clip is opened and positioned for penetrating the tissue as shown inFIG. 8C.

FIG. 8A shows a portion of clip 510 positioned in slot 623 with clip 510at the distal end portion of body member 620 and in a partially open orintermediate configuration. Clip delivery apparatus 300 and clip 510 isthen distally translated to a predetermined penetration depth “P” intothe artery as shown in FIG. 8B. The penetration depth P is sufficient toposition tips 503 of clip 510 beneath artery wall W without touching thewall. As noted above, the depth P may be determined by markings orindicia on delivery apparatus 300. With the delivery apparatuspositioned as shown in FIG. 8B, sheath 301 is held in place with bodymember 620 secured thereto, while inner member 303 with clip holder 611attached thereto is retracted or proximally translated from artery A,for example, by pulling on inner knob 306 (FIG. 3A). Since holder 611,which is attached to inner member 303, is releasably attached to clip510, the clip moves proximally along sloped surfaces 625 as clip holder611 is retracted. This forces rings or disks 409 against the clip coils407 and toward the piercing ends of clip 510 to further open the clip(FIG. 8B). Clip holder 611 is further retracted so that disks 409 engageparallel surfaces 627 as shown in (FIG. 8C), where the bias forces causethe clip to assume an open configuration with the piercing ends ready toengage the inner surface of a portion of the tissue adjacent theopening.

With clip 510 in the open configuration as shown in FIG. 8C, clipdelivery apparatus with inner member 303 and clip holder 611 isretracted or proximally translated causing clip 510 to pierce wall W andbridge the opening, e.g., on diametrically opposed sides of opening O(FIG. 8D). With the open clip penetrated through wall W, clip holder 611is further retracted to release clip 510 therefrom. Sheath 301 and innermember 303 with holder 611 are further proximally retracted together,for example, by pulling on inner knob 306 and outer knob 304 causingtissue edges surrounding the opening to slide along the clip and cometogether. The apparatus is further retracted causing body member 620 torelease the clip, thereby allowing the clip to move toward its closedconfiguration 410C as shown in FIG. 8E and hold or secure the tissueedges together. In this manner, the opening can be sealed.

For some types of tissue, the clip piercing members 501 may be left inplace. Examples of tissue which may not be sensitive to retaining apiercing member include stomach, bowel or colon tissue. For other typesof tissue, such as coronary, aorta or other blood-carrying tissue, itmay be preferable, though not necessary, to remove the piercing membersfor various reasons including to promote healing of the puncture site,to prevent further piercing of the tissue, or to reduce the likelihoodof irritation of the tissue. In the foregoing example, which involvesclosure of an opening in a femoral artery, the piercing members 501 canbe removed from the clip by cutting, or they can be removed by pullingthe piercing members 501 off the clip when a releasably mounted piecingmember configuration is used such as that shown in FIG. 5B. Variouspiercing member removal apparatus are described in detail below inaccordance with further aspects of the invention.

Referring to FIG. 9, clip delivery apparatus 900, which includes apiercing member removal mechanism in accordance with another embodimentof the invention, is shown. More specifically, clip delivery apparatus900 is the same as clip delivery apparatus 300 with the exception ofhaving a piercing member removal apparatus incorporated therein.

Delivery apparatus 900 extends from a proximal end 909 to a distal end905, and includes a sheath or tubular outer member 901 having an outerknob 904 near the proximal end, and an inner member 903 (which can be asolid or tubular rod) extending substantially along the length of thedelivery apparatus and having an inner knob 906 secured thereto orformed therewith at the proximal end of the apparatus.

A slot 907, which is the same as slot 307, bisects a distal portion ofsheath 901 in a longitudinal direction and extends along diametricallyopposed portions or sides of the distal end portion of the sheath.Delivery apparatus 900 provides for the delivery of a clip through slot907 through actuation of inner knob 906 and/or outer knob 904 asdiscussed above in connection with delivery apparatus 300. Specifically,outer knob 904 is connected to sheath 901 near proximal end 909 by, forexample, welding or gluing or it is formed therewith so that outer knob904 can be used to axially translate or rotate sheath 901 along or aboutinner member 903. Inner knob 906 is connected to inner member 903 suchas by welding or gluing. In turn, the distal end of inner member 903 iscoupled to a clip holding and release mechanism or it can form part ofsuch a mechanism such as the clip holding and release mechanismdescribed above with reference to FIGS. 6-8. With knob 906 secured toinner member 903, knob 906 can be used by an operator or surgeon toaxially translate or rotate inner member 903 relative to sheath 901 toactuate the clip holding and release mechanism and load a clip in ordeploy a clip from apparatus 900.

Delivery apparatus 900 has a generally cylindrical shape that terminatesin a curved or blunt distal end portion like delivery apparatus 300.This shape facilitates the use of the device to remotely place clipsthrough surgical openings in a body and release the clips from distalend 905.

In addition, clip delivery apparatus 900 includes a pair of piercingmember removal mechanisms and actuators for actuating the removalmechanisms, which are generally indicated with reference numeral 910.Each piercing member removal mechanism 910 includes a pair of supportmembers 917 and piercing member intercepting or restraining portions919, which in the illustrative embodiment are provided at or secured tothe distal end of the support members. Support members 917 can have anysuitable shape for providing a support or base for intercepting portions919. For example, each support member 917 can be a flat elongated memberor it can have a semi-circular, crescent, rectangular, square, or othertransverse cross-sectional shape. The proximal ends of support members917 are connected to arms or rods 913, which extend proximally besidemember 303 and connect to plunger arms 911. Alternatively, arms 913 andplunger arms 911 can be integrally formed. Plunger arms 911 extendthrough diametrically opposed slots, which are formed in sheath 901 andextend in a longitudinal direction sufficiently to allow plunger arms911 to move between two positions. In the proximal most position,plunger arms are in a fully retracted, proximal position as shown indashed line and the removal mechanisms 910 are retracted throughopenings in sheath 901. In the distal most position, plunger arms are inthe position shown in FIG. 9 and removal mechanisms 910 are extendedfrom the opening for engaging piercing members. In this manner, plungerarms 911 and rods 913 actuate deployment of removal mechanisms 910.

Referring to FIGS. 10A-C, one removal mechanism arrangement will bedescribed where FIGS. 10A and 10B illustrate retracted and extended sideviews of the distal end portion of clip delivery apparatus 900 and FIG.10C is a front view of FIG. 10B. Removal mechanism 910 are shown in aretracted position in FIG. 10A and in a deployed position in FIG. 10B.As shown in FIG. 10C, sheath 901 has a pair of diametrically opposedsloping portions 1003, which slope outwardly in a distal direction, andopenings 1001 at the proximal end of sloping portions 1003. When plungerarms 911 are moved distally, rods 913 and removal mechanisms 910 aremoved therewith. Piercing member removal mechanisms 910, each having anend portion lodged between a respective opening 1001 and portion 1003 toposition or guide rods 913, slide distally and outwardly along slopingportions 1003 of sheath 901, thereby positioning intercepting portions919 to engage piercing members such as piercing members 501′. Openings1001 and sloping surfaces 1003 can be made by forming diametricallyopposed transverse cuts in tubular sheath 901 and radially compressingthe sheath distally of the cuts.

Referring to FIGS. 11A to 11E, delivery apparatus 900 isdiagrammatically shown sealing a tissue opening with a clip havingremovable piercing members 501′. FIG. 11A shows clip 510′ coupled toclip delivery apparatus 900 and beneath opening O in vessel wall W. If acannula or sheath had been used to surround clip delivery apparatus 900for insertion into opening O, it has, at this point, been retracted toallow for unimpeded operation of piercing member removal mechanisms 910.Clip 510′ is shown in an open position with removable piercing members501′ adjacent wall W. Plunger arms 911 are moved distally to deployremoval mechanisms 910 from sheath 901 as shown in FIG. 11B. The removalmechanisms are configured and arranged so that when they are fullydeployed, intercepting portions 919 oppose removable piercing members501′ as shown in FIG. 11B.

Referring to FIG. 11C, inner member 903 is proximally translated to pullor force clip 510′ proximally and pierce wall W in a manner similar tothat shown in FIG. 8D. In addition to piercing wall W, removablepiercing members 501′ enter or engage intercepting portions 919.Intercepting portions 919 are configured to hold or capture removablepiercing members 501′ or to allow only one-way travel therethrough. Asplunger arms 911 (not shown) are retracted to retract removal mechanisms917 within sheath 901, piercing members 501′ are removed from clip 510′(FIG. 11D). Clip delivery apparatus 900 is further retracted toapproximate the tissue edges of the opening along the clip and thenfully retracted from the wound site, removing piercing members 501′ fordisposal, ejecting clip 510′ and allowing clip 510′ to move toward aclosed loop configuration to hold the tissue edges together (FIG. 11E).Although this example has been made with reference to a vessel wall andclip 510′, the apparatus can be used to seal other openings and otherclips can be used.

Intercepting portions 919 can have various configurations. Referring toFIGS. 12A to 12C, one embodiment for intercepting portion 919 is shownand generally designated with reference numeral 919′. Interceptingportion 919′ comprises a thin sheet of mesh 1201, which is secured tothe distal edge of support member 917. Intercepting portion 919′ can beetched stainless steel and welded or brazed to the end of support member917. Mesh 1201 includes a plurality of holes 1203 that are slightlysmaller than the diameter of piercing members 501′. FIG. 12Adiagrammatically illustrates clip 510′ with piercing member 501′approaching a mesh hole 1203 and FIG. 12B shows the piercing memberbeing forced through the mesh hole. Once piercing member 501′ has fullypassed through the mesh hole, it is not retractable due to its basehaving a larger diameter than that of the hole. As the removal mechanismis retracted, piercing member 501′ is caught in mesh 1201 and removedfrom the clip.

FIGS. 13A to 13C illustrate another embodiment of intercepting portion919, which is generally designated with reference numeral 919″.Intercepting portion 919″ comprises a flap 1301 having a plurality ofslits 1302 formed therein and having a width less than the base of thepiercing members for trapping a piercing member. Slits 1302 can beparallel as shown in the drawings or they can be otherwise arranged. Forexample, they can be arranged in parallel on a diagonal. Alternatively,they need not be arranged in parallel. Intercepting portion 919″ can beetched stainless steel and welded or brazed to the end of support member917. Intercepting portion 919″ can be formed from a single sheet ofmaterial and folded to form peak or edge 1307. Alternatively,intercepting portion 919″ can comprises two connected portions 1303 and1305 that are folded to form a peak or common edge 1307. In either casethe peak is formed to extend in the same direction as approachingpiercing member 501′. This configuration assists in guiding the piercingmember toward the region where edge 1307 is formed, which can be at thecenter of intercepting portion 919″. Accordingly, peak 1307 can bearranged to guide the piercing member to the center of interceptingportion 919″.

FIG. 13A shows clip 510′ with piercing member 501′ approachingintercepting portion 919″. FIG. 13B shows the piercing member beingforced through peak or edge 1307 of the flap. FIG. 13C shows the flapportions closing about the clip below the piercing member, thusresisting or precluding the piecing member from passing through the flapin the reverse or opposite direction. As the removal mechanism isretracted, intercepting portion 1301 separates piercing member 501′ fromthe clip and the piercing member is removed with the removal mechanism.

Variations and modifications of the devices and methods disclosed hereinwill be readily apparent to persons skilled in the art. As such, itshould be understood that the foregoing detailed description and theaccompanying illustrations are made for purposes of clarity andunderstanding, and are not intended to limit the scope of the invention,which is defined by the claims appended hereto. Further, allpublications, patents, and patent applications cited herein are herebyincorporated by reference in their entirety for all purposes.

1. A surgical clip comprising an elongated member and a pair of biasingmechanisms coupled to said member, said elongated member comprisingshape memory material and having a memory set closed configuration fromwhich it is moveable to a plurality of open configurations, said biasingmechanisms being selectively adjustable to bias the clip toward any ofsaid plurality of open configurations, each biasing mechanism comprisinga biasing member and an actuator, each biasing member adapted to apply abiasing force to said elongated member to urge said elongated memberaway from said closed configuration, and each actuator being coupled toone of said biasing members and adapted to activate said biasing memberto apply said biasing force to said elongated member.
 2. The surgicalclip of claim 1 wherein each biasing mechanism comprises a coil and asliding member, each coil surrounding a portion of said elongated memberand each sliding member being slidably mounted to said elongated memberto slidably engage one of said coils.
 3. The surgical clip of claim 2wherein each sliding member comprises a disk having an opening formedtherethrough, said elongated member extending through each opening. 4.The surgical clip as in claim 1 wherein said elongated member has twoends and said ends form enlarged portions of said clip.
 5. The surgicalclip of claim 4 further including tissue piercing members releasablycoupled to enlarged portions.
 6. The surgical clip as in claim 1 whereinsaid elongated member has two pointed ends adapted to pierce tissue. 7.The surgical clip as in claim 1 wherein said biasing mechanisms aresymmetrically arranged about said elongated member.
 8. The surgical clipof claim 7 wherein said elongated member has two ends and said ends formenlarged portions of said clip.
 9. The surgical clip of claim 8 furtherincluding tissue piercing members releasably coupled to said enlargedportions.
 10. A surgical clip comprising an elongated member and a pairof biasing mechanisms coupled to said member, said elongated membercomprising shape memory material and having a memory set closedconfiguration from which it is moveable to a plurality of openconfigurations, said biasing mechanisms being selectively adjustable tobias the clip toward any of said plurality of open configurations, saidelongated member further having two tissue piercing members secured toand engaging said elongated member and extending therefrom.
 11. Thesurgical clip of claim 10 wherein said piercing members are releasablysecured to said elongated member.
 12. The surgical clip of claim 11wherein said biasing mechanisms are symmetrically arranged about saidelongated member.
 13. The surgical clip of claim 10 wherein said biasingmechanisms are symmetrically arranged about said elongated member.
 14. Asurgical clip comprising an elongated member and a pair of biasingmechanisms coupled to said member, said elongated member comprisingshape memory material and having a memory set closed configuration fromwhich it is moveable to a plurality of open configurations, said biasingmechanisms being selectively adjustable to bias the clip toward any ofsaid plurality of open configurations, said elongated member furtherhaving two tissue piercing members integrally formed therewith.
 15. Thesurgical clip of claim 14 wherein said biasing mechanisms aresymmetrically arranged about said elongated member.
 16. Surgical clipdelivery apparatus for delivering a surgical clip as described in claim1, said apparatus comprising: a body member having an opening adapted toallow said surgical clip to pass therethrough for release thereof; aclip holder disposed in said body and adapted to releasably hold saidsurgical clip; and a controller having multiple actuator engagingsurfaces disposed in said body member, said multiple surfaces configuredto engage said clip actuators to adjust the force that the biasingmember applies to said clip.
 17. The apparatus of claim 16 wherein saidcontroller has a slot formed therein which is adapted to receive saidelongated member.
 18. The apparatus of claim 17 wherein said controllerslot is arranged so that said actuators engage at least two of saidengaging surfaces when the elongated member of said surgical clip ispositioned in said slot.
 19. The apparatus of claim 18 wherein said bodymember has a distal end and a proximal end and said body member openingcomprises a slot, which is formed in said body member and extends fromsaid distal end, said body slot being aligned with said controller slot.20. The apparatus of claim 16 wherein said engaging surfaces includesloped surfaces.
 21. The apparatus of claim 20 wherein said engagingsurfaces further include parallel surfaces.
 22. The apparatus of claim16 further including tissue piercing member removal mechanisms coupledto said body member, said tissue piercing removal mechanisms havingportions adapted to capture tissue piercing members when coupled to saidclip.
 23. A surgical system for closing an opening in tissue comprising:a self-closing clip as described in claim 1; a body member having anopening adapted to allow said surgical clip to pass therethrough forrelease thereof; a clip holder disposed in said body member and adaptedto releasably hold said surgical clip; and a controller having multipleactuator engaging surfaces disposed in said body member, said multiplesurfaces configured to engage said clip actuators to adjust the forcethat the biasing member applies to said clip.
 24. The system of claim 23wherein said controller has a slot formed therein which is adapted toreceive said elongated member.
 25. The system of claim 24 wherein saidcontroller slot is arranged so that said actuators engage at least twoof said engaging surfaces when the elongated member of, said surgicalclip is positioned in said slot.
 26. The system of claim 25 wherein saidbody member has a distal end and a proximal end and said body memberopening comprises a slot, which is formed in said body member andextends from said distal end, said body slot being aligned with saidcontroller slot.
 27. The system of claim 23 wherein said engagingsurfaces include sloped surfaces.
 28. The system of claim 27 whereinsaid engaging surfaces further include parallel surfaces.
 29. The systemof claim 27 further including tissue piercing member removal mechanismscoupled to said body member, said tissue piercing removal mechanismshaving portions adapted to capture tissue piercing members when coupledto said clip.
 30. A surgical system for closing an opening in tissuecomprising: an elongated body member having a proximal end and a distalend adapted for introduction into a tissue opening, said elongated bodymember further having an opening therein; and a surgical clip havingends, an open configuration and a closed configuration, said surgicalclip being releasably coupled to said elongated body member and arrangedso that when in said open configuration said clip ends extend from saidelongated body opening at diametrically opposed portions of said bodymember and generally point toward the proximal end of said body memberso that when said body member is introduced info the tissue opening andthe surgical clip moved to said open configuration, the ends of saidsurgical clip can penetrate the tissue adjacent the opening-therein whenthe body member is retracted. 31-38. (canceled)